Joni Lavick has been helping people with HIV since 1986. Now she's a therapist specializing in people with HIV at the L.A. Gay and Lesbian Center.

A Therapist to HIV-Positive PeopleThis introduction was written by Joni Lavick.

I have a gift. I find wallets. And every wallet I have ever found has been returned to its owner.

I was 11 when I found my first wallet in the toothpaste aisle of the Texa-Tonka Drug Store in my hometown; St. Louis Park, Minn. It was an exciting find, full of ID, credit cards and cash! I took it home, showed it to my mother and together we tracked down the owner. We looked up her name in the phone book, delivered the wallet to her door, and received her thanks. I remember she sent me a thank-you note with some lacy handkerchiefs with the initial J (not my style, at all)!

"... helping clients find the right questions to ask is more problematic that the old dilemma of unanswerable questions!"

Since then, I have found seven more wallets. I found one on Main Street in Santa Monica that belonged to a dentist who was visiting from Oregon with over $600 in cash. I tracked him down through his office. I've had two finds in movie theaters; one was a pink plastic "Hello Kitty" wallet with a Nordstrom gift certificate inside which I returned to a crying eight-year-old with a grateful mother at her side in the lobby of the theater.

I found a wallet in a Greyhound bus station; this owner was miffed that she had to come to my house to get it. I guess she expected delivery. The owner of the wallet I found on the floor of a taxi cab in New York City was extremely suspicious and brought her "bodyguard" boyfriend along when she picked it up. The one that required the most detective work to return was a find in a parking lot. It had lots of cash, but the only piece of identification was an auto registration receipt with the license plate number from a car. I walked through the lot, found the car, left a note with my phone number under the windshield wiper, and was able to return it to the owner.

My karma as a wallet finder is a perfect metaphor for the work I do. It is the act of returning something valuable to someone who thinks they may have lost it forever. Most people are motivated and engaged in the process of finding what they have lost and some are suspicious and skeptical, but for me, the work is always new and unique. It's an investigation where I learn about myself and others.

PRACTICE

How long have you been working with people living with HIV?

Since 1988 I have helped people reclaim selves they have lost through the diagnosis of HIV/AIDS. I have asked hundreds of people, "What does it mean to you to be HIV positive?" Some answers point to adapting to this difficult challenge in a positive and productive manner. With those individuals, I help solidify that point of view and build on their strengths. For others, it can be the confirmation of every bad thing they have ever felt about themselves which has the potential to lead down a road of negativity and despair. With this group, the work is about finding a road to a more hopeful reality.

Can you describe how your work has changed since you first started?

In 1986, my friend Donald Grover was diagnosed with AIDS. Two short years later, he died. It was then I decided that I wanted to get involved in making some contribution to the fight against HIV/AIDS. In 1988, I became an emotional support volunteer for L. A. Shanti [an AIDS organization in Los Angeles]. The next year, I enrolled in graduate school for my Master's in Counseling Psychology and in 1991 I began working at the L.A. Gay & Lesbian Centers HIV Healthcare Center.

For me, those years were characterized by helping people cope with death and dying and the uncertainty of what it meant to be HIV positive. There were more questions about HIV than answers and only one drug for treatment (AZT). There were few resources for diverse populations like women, heterosexuals, older adults, Latinos and African Americans. Many individuals were shell-shocked from multiple losses of friends and lovers.

Today, I help people cope with living with HIV. Treatment has become complex, diagnostic procedures amazingly sensitive, and helping clients find the right questions to ask is more problematic that the old dilemma of unanswerable questions!

If I were to follow you over the week, what would I see you do at work? Please give details of all the things you actually do (i.e., talking to clients ... writing grants ... whatever.)

As Director of Mental Health Services at the L.A Gay & Lesbian Center (LAGLC) and a psychotherapist in private practice, my weeks are extremely varied. I see about 15 clients for weekly individual therapy (about half of those are HIV positive), I do one group therapy session each week for MSM's [men who have sex with men] (both HIV positive and HIV negative) who identify as being sexually compulsive. Four hours each week, I provide clinical supervision for counseling interns learning to be therapists. Over the years I have had many interns who are HIV positive and have helped them address whether or not to disclose their HIV status to their clients. The rest of my week, I direct the mental health program we have here at LAGLC. I write grants, monitor grant expenses and contract reports, oversee quality assurance, develop new programs and complete the myriad of other issues that everyone in mental health management faces. I love to teach. I speak at conferences and provide outreach and education to other community-based organizations and AIDS organizations.

A snapshot of a typical day would include two morning appointments for psychotherapy with clients starting at 11 a.m. As I said, my clients are mostly HIV positive. Many are dealing with other issues as well, like methamphetamine addiction, Schizo-Affective disorder and general depression. From 1 to 3 p.m. I supervise a group of interns. In the afternoon, I see more patients for therapy.

What's the best thing about your job?

The best thing about my job is helping people one by one. As a psychotherapist, I love the idea that I am changing the world one person at a time. Every person I help to increase their sense of self-esteem, heal wounds of the past, or deal with the challenges of the present has the potential to effect positive change in the world.

I enjoy working with sero-different (mixed HIV status) couples. I get pleasure in the process of helping couples see each others point of view, learn how to tolerate the others feelings and their own simultaneously, and how to support each other through this oftentimes challenging dynamic.

What have been your greatest successes in your work? Greatest failures?

It may not be the worst thing about my job, but dealing with bureaucracy, trying to effect change on the organizational level, tending to important but taxing administrative details, and attending lots and lots of meetings can sometimes try my patience. I think this is a common dilemma for many of us who choose this work. We have great reserves of tolerance for individuals in pain, who are struggling to change their lives, but this doesn't always transfer to organizations! Still, I am proud of organizations like The L.A. Gay & Lesbian Center (my employer) that give us the infrastructure to do the work we do -- we could not deliver our services without them. I appreciate the contributions they make and understand the obstacles they encounter.

What is the biggest challenge you face as a case manager/social worker?

One of the most challenging periods of my career was the five years when I worked as a home health provider of psychotherapy for AIDS Project Los Angeles. Jokingly, I referred to myself as the "drive-by" psychotherapist. The act of visiting someone in the end stages of AIDS in their home is a sobering experience. Actually seeing the bottles and bottles of medications and the IV poles for multi-hour medication infusion, smelling the antiseptic aroma that is the by-product of turning your home into a hospital room, and hearing how the individuals interact with their partners, home-health aides and even pets brings the reality of what it means to have AIDS into undeniable focus.

For the most part, what do you think is the biggest risk factor for HIV?

The biggest risk factor for HIV is low self-esteem. Self-care is one of life's greatest challenges. It means staying in the moment, knowing the difference between what we want and what we need, and it is an on-going and ever-changing process throughout our lives. I have asked hundreds of individuals, "which is more difficult, the anxiety of staying negative or being positive." The answer is practically unanimous -- staying HIV-negative may create fear and anxiety and the need for constant vigilance, but tolerating the fear and anxiety of being HIV-positive is more difficult.

What is the most important, memorable or useful thing you have learned from the people you work with?

Answering this question seems almost impossible. I learn from people every day. I learn how resilient and how fragile individuals can be. I have seen the many ways people become their own worst enemy and I hope that I have learned to be better to myself. I am constantly inspired by my clients' courage to confront their issues and heal their wounds. I am inspired by the dedication of my co-workers.

How do you maintain a positive outlook and avoid burning out?

I think I am able to maintain a positive attitude and avoid burn-out through the way I express my emotions. I am not a "blank screen" -- I don't even believe that it is possible to be one. I am authentic and genuine and I do not hide my feelings from my clients. I express sadness, frustration, pride and even anger! I have a sense of humor and I'm not afraid to use it. I am also very good at caring for myself. I have great support in my personal life and I come from a loving family. Although I think that many of my clients appreciate me, I do not require that appreciation. I know I do my job to the best of my ability and I feel very good about the work I do.

"I feel disclosure is harder for women and support services are not as prevalent. Taking care of self and family can be overwhelming and women are more isolated."

If you weren't doing what you are doing now what would you be? Why?

I love being a psychotherapist and hope to be doing it for the next 20 years. I would like to be more independent and I am working on developing my private practice, but I love the world of non-profit. I guess the one thing I haven't done is write. I have a message and I would like to write to get my ideas out to more people.

Do you see a lot of women now? What are their lives like? What kind of services do they often need that are different than the services men need?

About 10% of the HIV-positive people I see are women. We have a long way to go for women. Clinical trials are still dominated by men. I feel disclosure is harder for women and support services are not as prevalent. Taking care of self and family can be overwhelming and women are more isolated. There is a way that women carry and adjust to their diagnosis that differs from men. Incorporating the reality of one's HIV status into one's view of self is difficult for everyone, but for women, who have pictured the primary goal of their lives to be wives and mothers, the adjustment can turn that picture upside down. I watch women face and overcome this challenge. The strength and dignity women show, often in profound isolation and with a lack of social support, is what inspires me.

What was your first reaction when told about this award?

At first, I wondered about winning in this category, since I see myself more as a psychotherapist/social worker than a case manager. But when you work with HIV, case management is part of the territory. I have referred clients to drug treatment, housing, dental care, social security disability, 12-step groups, dozens of AIDS organizations, spiritual support, psychotherapy and support groups, food banks, alternative treatment resources and on and on.

Who would you dedicate this award to if you could?

Dedicating this award is easy. I am typical of many in the field and I share this award with them. Thanks so much for choosing me!

PERSONAL

When did you decide you wanted to be a social worker?

I became fascinated with mental illness in my pre-teen years. Movies like "One Flew Over the Cuckoo's Nest" and "The Birds" and books like Sybil, I Never Promised You a Rose Garden and The Bell Jar, all opened my mind to the reality that not every mind is organized in the same fashion. From the time I was in the ninth grade, when I did my career project on Psychiatric Social Work, I knew this was the field for me.

What was your major in college?

I have a B.A. in social work from the University of Minnesota, and a Master's in counseling psychology from Loyola Marymount University of Los Angeles. I continued my education for another five years at the Institute for Contemporary Psychoanalysis here in Los Angeles. For the past two years, I have been in a weekly supervision group with Robert Stolorow. I find it useful to breakdown psychoanalytic techniques and concepts into practical constructs that help my clients.

What other jobs have you had?

My favorite job of the past was the 10 years I spent as a grocery checker at Ralph's Supermarket. It was just like being a therapist only the sessions were shorter! I saw the same people every week; I got tuned into their emotional lives, met their partners and families, and even did an analysis of the food they bought. Some of my favorite combinations were: the woman who came in on Friday nights and bought a steak, a potato and bottle of Scotch (Major Depressive Episode), the folks with cartfuls of junk food with diet soda (just plain denial), or no food at all but tons of cleaning products (Obsessive-Compulsive Disorder), you get the idea.

Where do you live? What kind of community is it? What do you like or dislike about it?

I live in Santa Monica, California. I am an "I love L.A." person. I love the diversity. I enjoy tasting foods from every culture. I enjoy all the different neighborhoods. I love to drive and do not suffer from road rage (quite a skill in this town). I really use the city I live in, I go to concerts, plays, movies, museums, I shop, I walk, and I hike in the Santa Monica Mountains and the Angeles National Forest.

What do you do in your spare time?

I'm big on exercise. I work out regularly; I've been training with same personal trainer twice a week for the past eight years. I like the gym and fight the local Hollywood every-woman-should-be-a-size-zero pressure. Curves are good!

The Body is a service of Remedy Health Media, LLC, 750 3rd Avenue, 6th Floor, New York, NY 10017. The Body and its logos are trademarks of Remedy Health Media, LLC, and its subsidiaries, which owns the copyright of The Body's homepage, topic pages, page designs and HTML code. General Disclaimer: The Body is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through The Body should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.